Mariana De Oliveira Nunes1, Dawn R Witt2, Susan A Casey3, Cynthia K Rigsby4, Anthony M Hlavacek5, Shahryar M Chowdhury6, Edward D Nicol7, Thomas Semple8, John R Lesser9, Katelyn M Storey10, Miranda S Kunz11, Christian W Schmidt12, Larissa I Stanberry13, B Kelly Han14. 1. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: mariana.nunes@allina.com. 2. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: dwitt@mhif.org. 3. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: sue.casey@allina.com. 4. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. Electronic address: crigsby@luriechildrens.org. 5. Medical University of South Carolina, Charleston, SC, USA. Electronic address: hlavace@musc.edu. 6. Medical University of South Carolina, Charleston, SC, USA. Electronic address: chowdhur@musc.edu. 7. Royal Brompton Hospital, London, UK. Electronic address: e.nicol@rbht.nhs.uk. 8. Royal Brompton Hospital, London, UK. Electronic address: t.semple@rbht.nhs.uk. 9. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: john.lesser@allina.com. 10. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: storka03@luther.edu. 11. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: mirandasue522@outlook.com. 12. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: christian.schimdt@allina.com. 13. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA. Electronic address: larissa.stanberry@allina.com. 14. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA; Children's Minnesota, Minneapolis, MN, USA. Electronic address: khan@chc-pa.org.
Abstract
BACKGROUND: Cardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known. METHODS: Four centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose. RESULTS: Cardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 mGy∗cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p < 0.001). Seven minor adverse events (0.7%) and no major adverse events were reported. CONCLUSION: Cardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.
BACKGROUND: Cardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known. METHODS: Four centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose. RESULTS: Cardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 mGy∗cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p < 0.001). Seven minor adverse events (0.7%) and no major adverse events were reported. CONCLUSION: Cardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.
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